How a hospital overcame the challenge

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Restrictions due to COVID-19 created new challenges for maintaining the values ​​of palliative care and educating medical students about it during the pandemic, Clarissa Johnston, MD, said during a virtual presentation at the annual meeting of the Society of General Internal Medicine.

Johnston, of the University of Texas at Austin, and colleagues experienced an extreme rise in COVID-19 when they reopened after the initial closure in the early weeks of the pandemic.

“Our hospital and our clinics are Austin’s health safety net and we serve a predominantly uninsured Hispanic population that experiences a higher COVID-19 load than the rest of the populations in our area,” he told the presentation.

The rapid emergence and spread of COVID-19 locally required physicians and staff to innovate rapidly, and “we developed and implemented new, collaborative collaborations between generalists and palliative care specialists to help ensure that our basic humanizing values ​​should not be lost in the pandemic “. Johnston pointed out.

The collaboration between internal medicine and palliative care involved the development of relationship-focused communications for families and health workers, as well as the participation of medical students in an optional Transitions of Care option. dir Johnston.

The first weeks of the pandemic impacted families without the visitor policy and the loss of death rituals, he said. Healthcare providers also suffered as nurses experienced work overload, fears for their own health and safety, and a sense of disconnection from their patients. Doctors addressed the challenges of a single disease and their own fears and uncertainty, Johnston said.

Find communication challenges

One of the strategies used to bridge the communication gap caused by the lack of visitors and family contact was the adoption of the Meet My Loved One program, adapted from a similar program at the University of Alabama, Johnston said. Meet My Loved One was a patient-centered collaborative effort with ICU, Johnston said. Members of the primary care team, including medical students in the Optional Care Transitions option, called relatives of ICU patients to collect personal data and humanizing information about the patient, such as the favorite name, favorite foods, favorite activities, and some personal background (i.e., he played basketball when he was young), and this information was collected, summarized, and posted on the patient’s bedroom door.

Maintain humanity

“COVID-19 has changed the way we interact with patients and families,” Johnston said in an interview. The inability to trust face-to-face discussions means that “we really need to think carefully about how we maintain humanity and human touch,” he said.

Among the challenges of providing palliative care during the pandemic are “keeping humanity, remembering that there is a person behind the patient prone and paralyzed, with family members who love him and are desperate to be with them but not they can, ”Johnston said.

“The Meet My Loved One program helped, as well as multidisciplinary rounds, chaplain services, and frequent consultations with night nurses,” she said.

“I tried to make an effort to call families every day to start building that trust and relationship that was lost through all the distancing and lack of visits. I didn’t realize how much families are witnessing the daily care of the patients with ICU. when they are in the room, “he noted. “During COVID-19, it was much harder to build trust, especially when the inequalities and structural racism issues of our healthcare system add up,” he said.

“Why did a family member believe and trust some random doctor to call them on the phone? Did we really try our best? Families had no way of evaluating it, at least not as they do when they are in bed and they see how everyone works hard, ”Johnston said. “The video tours helped, but they weren’t the same.”

Some key lessons about palliative care that Johnson said he learned from the pandemic were the importance of remembering the patient and family, “how we should work to build trust,” and that doctors should keep in mind that visits video games don’t work for everyone and for “ask, ask, ask about what you don’t know, including death rituals.”

Additional research needs in palliative care following COVID-19 include more information about what works and what doesn’t, from a patient and family perspective, Johnston said. Communication strategies are important and “we need to address how we can best communicate with black and brown communities around serious illness and end-of-life problems.”

Challenges of COVID care

One of the main challenges in providing palliative care during the early days of the pandemic was to navigate the ever-evolving science of COVID-19, said Aziz Ansari, DO, of Loyola University in Chicago, Maywood, Illinois, in a interview.

“It was, and still is, very difficult to predict how a patient with respiratory failure will do with COVID,” said Ansari, who was the leader of the Palliative Care Stakeholder at the SGIM.

“So the challenge was how to hold a conversation about goals, values, and preferences when we didn’t really know the entity of the disease,” Ansari noted.

“We were surprised many times [when patients with COVID-19] recovered although it took a long time, so we could not really say that in the acute phase of COVID it was a terminal illness “, he pointed out.

“Regardless, we still need to have conversations with our patients and families about what they are willing to go through and how they define a quality of life,” he said.

Ansari said strategies such as those used at the University of Texas show the importance of developing palliative skills in primary care. “Every physician should have the ability to hold conversations with patients and families about goals, values, and preferences even in unfamiliar situations,” he said. This development of lifelong skill sets begins in medical school, he added.

Johnston and Ansari had no financial conflict to reveal.

This article originally appeared on MDedge.com, which is part of the Medscape professional network.





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